Wednesday, August 31, 2011

This summer, Tobacco-free Take Action! volunteers at the University of Kentucky have been circling campus, asking students to put out their cigarettes while on school property. UK is one of about 530 U.S. colleges that have enacted smoke-free policies. (Photo from University of Michigan)

Most of the bans are considered comprehensive, with smoking prohibited on all grounds, including athletic facilities, restaurants and parking lots, reports CNN's Stephanie Steinberg. That is the case at UK, which enacted its ban in November 2009. Then, just 300 college campuses had similar bans in effect. Within the past year, 120 campuses were added to the smoke-free list nationwide. Today, in addition to UK, Bellarmine University, Kentucky Wesleyan College, Morehead State University, Pikeville College, Spalding University, St. Catharine College, Union College and University of Louisville are smoke-free, according to the American Nonsmokers' Rights Foundation.

The Centers for Disease Control and Prevention reports about 46 million Americans age 18 and older smoke cigarettes. A 2010 American College Health Association report found 4.4. percent of the more than 30,000 students surveyed had smoked every day in the past 30 days. In Kentucky, about 26 percent of adult Kentuckians smoke.

Since UK enacted its ban in 2009, a growing number of people have gotten help to quit smoking at the university. "After the policy's first year, enrollment rose to 146 people," up from 33 the year before, Steinberg reports. "The number of nicotine replacement coupons redeemed by students and faculty also increased from 124 to 470 in the same period."

One of the keys to changing mindsets is to avoid being too heavy-handed, Steinberg reports. "We certainly don't have smoking police," said Ellen Hahn, director of UK's Tobacco Policy Research Program. Instead student volunteers gently remind others of the policy while offering smoking cessation information.

Ty Patterson, former vice president of student affairs at Ozarks Technical Community College in Missouri, predicts that in 10 years almost all college campuses in the country will be smoke-free. "We've gone from pushing smoking out of the building . . . to now trying to push smoking totally off campus," said Laura Talbott Forbes, chairwoman of the 2010 American College Health Association's Alcohol, Tobacco and Other Drugs Coalition. (Read more)

Tuesday, August 30, 2011

Featuring the insight of 42 federal, state and local health experts, officials and community leaders, the Appalachian Regional Commission's Healthy Families: Healthy Future conference will be held Sept. 7-9 in Prestonsburg.

The keynote address will look at different ways access to quality health care can be expanded. It will be given by Marcia Brand, deputy administrator of the Health Resources and Service Administration. HRSA is the primary federal agency for improving access to health-care services for people who don't have insurance, are geographically isolated, or are medically vulnerable.

In an op-ed piece, veteran Kentucky journalist Al Smith praised the recent announcement that 25,000 Eastern Kentucky children in 16 counties will receive preventive dental care this school year.

The project, funded by a $1 million grant from the Appalachian Regional Commission and $250,000 in state funds, will involve painting the teeth of those children with a special varnish that prevents tooth decay. As co-founder of the Institute for Rural Journalism and Community Issues and former federal cochair of the ARC, Smith has pushed long and hard for the improvement of oral health in Kentucky.

He spoke of the grant announcement in conjunction with discussions of the continued $900 million expansion of the University of Kentucky's Chandler Medical Center. "Obviously, the bricks and mortar go to serve extremely important life saving and health purposes, but the ARC pilot treatments of children's teeth should persuade all Kentuckians that this care is essential for every county," he wrote.

The project is called Healthy Smiles and was announced by Gov. Steve Beshear last week. "Over the course of 2011-2012 school year, two protective fluoride tooth varnish treatments and educational materials for healthy dental practices will be offered to children in the first through fifth grades at selected schools," Smith summarized.

The Institute for Rural Journalism and Community Issues told Beshear about Kentucky's serious oral health deficits when he was running for governor four years ago, Smith said in his op-ed piece. That assessment showed "that half of Kentucky's children had decay in their baby teeth; and nearly half of children ages, 2, 3, and 4 had untreated dental problems," Smith wrote.

Cavities and loss of teeth create problems in later life, Smith asserted. He referred to statements made by Dr. Steve Davis, interim commissioner of public health, who said Kentuckians looking to join the military may be turned away if they have a mouthful of oral health problems: "The Navy, particularly, takes seriously the warning that a sailor stricken by a toothache in the depths of the sea could mishandle a task on a sub and send the craft plunging to the bottom." For a Word version of Smith's op-ed, click here.

Monday, August 29, 2011

Update, Sept. 2: A new study has shown giving employees time to exercise during their work day could lead to increased productivity, as reported in the Journal of Occupational and Environmental Medicine. The study involved employees at a large public dental health organization in Sweden. On group of employees was required to do 2.5 hours of exercise per week during regular hours. "Another group received the same reduction in work hours, but with no exercise program," research-reporting service Newswise reports. Employees assigned to the exercise program said they felt productive while at work and were absent less often due to illness. (Read more)

Four state agencies allow their employees to take time to exercise as part of their work day, part of an effort to improve morale and productivity. The Department of Financial Institutions, Department of Military Affairs, Department of Veterans Affairs and the Personnel Cabinet have instituted the policies with varying degrees of participation.

"Some workers are limited to 90 minutes of paid exercise per week, while others can exercise up to five hours while on the clock," reports Valarie Honeycutt Spears of the Lexington Herald-Leader. "On any given day, employees can exercise from 30 to 60 minutes, depending on which agency they work for." (Photo of state employee Lisa Clark by H-L's David Perry)

It is unclear how many state employees take advantage of the policies, but officials feels it is cost effective. "A wellness break is just like any other break time," said Crystal Pryor, spokeswoman for the Personnel Cabinet. "The difference is that this break results in reduced absenteeism, increased productivity, higher employee morale and lower health care costs for the Kentucky Employees' Health Plan, the state's self-funded insurance program."

One 2010 Harvard University study showed medical costs fall about $3.27 for every dollar spent on wellness programs. Absentee day expenses drop by $2.73 per dollar spent. Despite the savings, Kentucky is one of the only states to have such exercise policies in place. Montana also does, allowing employees two 15-minutes exercise breaks a day.

"Often these employees are discussing work issues while they are exercising so we really don't see this as cutting back on productivity," said Dick Brown, spokesman for the Department of Financial Institutions. "There are no hard facts around the impact of the program on reduction of sick leave, but certainly that is one of the benefits and trade-offs we hope to see over time." (Read more)

Sunday, August 28, 2011

"In an era of tight budgets and strained resources, Kentucky and its rural communities can no longer afford 'business as usual' in the delivery of health care services," write Susan Zepeda and Amy Watts of the Foundation for a Healthy Kentucky. "As health care costs increase and health status declines, the question becomes: How can we ensure rural Kentuckians get better health care at lower costs?"

Zepeda, the foundation's president, and Watts, is senior program officer, see "promising opportunities" for rural communities to reshape health care, such as working with local health departments and civic leaders to "create communities that support healthy behaviors" and better integrate the health system, with special attention for the chronically ill.

These and other issues and ideas for rural health are on the agenda of the foundation's ninth annual Howard L. Bost Memorial Health Policy Forum, to be held Tuesday, Sept. 13 at the Center for Rural Development in Somerset. The forum will include state and national leaders. "Rather than wait for solutions from Washington, forum speakers will share strategies Kentucky’s civic leaders can put into place at the local, state and regional levels. Many will share ways that Kentucky is already doing this," Zepeda and Watts write in an op-ed article distributed to Kentucky newspapers.

The keynote speaker will be Dr. Len Nichols, who founded and directed Health CEOs for Health Reform, a group that helped policymakers see that reform of health insurance and health-care can be reformed together. Dr. Kavita Patel, a physician and former RAND Corp. researcher now at the Brookings Institution, will bring insights on how to achieve better care and better health at lower costs. Other experts from Kentucky, Virginia, Tennessee and North Carolina will share "practical policy strategies for positive health change in these challenging times," and smaller sessions will allow participants to engage with the speakers, Zepeda and Watts write, saying the forum's goal is to "provide accessible, safe and effective health care to nearly half of Kentucky’s citizens who call rural Kentucky home." More information is available on the foundation’s website, http://www.healthy-ky.org/.

In the Smiling Schools program, children in first to fifth grades "will have their teeth painted with two fluoride treatments over a four- to six-month period," reports Mike Wynn of The Courier-Journal. "Fluoride prevents and reverses the early affects of tooth decay and slows the progress of existing problems."(Photo by James Mann, The Winchester Sun: Emily Havens of Clark County gets the treatment)

The University of Kentucky Dental School will examine the children before and after the tooth varnish treatments to assess the effectiveness of the program. Results of a project that Beshear said inspired the program are promising. About 3,000 children in Clark County had their teeth painted with the varnish and decay rates in a group of sixth graders fell dramatically. By the third year of the treatment, decay rates had fallen from 50 percent to 14.5 percent, one of the lowest rates in the state, said dentist Rankin Skinner, who spearheaded the project.

In 2001, Kentucky children had tooth decay in their baby teeth almost twice as often as the national average, Beshear said Thursday. More than 46 percent of children ages 2 to 4 went untreated that year. "The impact of these dental problems is much more than just an uneven smile or a poor national image, Beshear said. "Dental problems affect overall health and development — everything from nutritional choices to speech development to performance in school." (Read more)

Rachel Parsons of The Winchester Sun reports that the impetus for the project was a December 2007 New York Times story about Kentucky's poor dental health, particularly that of children. Prompted by his son who read the story, Will Hodgkin of the Clark County Community Foundation contacted Skinner, who had learned of the varnish while completing a study in Ecuador, where dentists had noted big decreases in decay rates after using the substance on teeth. The foundation funded treatment for all preschool and elementary students in 2008-09, and the program is now run by the Clark County Health Department. (Read more)

In the face of a bad economy and people putting off health care to save money, Jewish Hospital is cutting 155 positions at its downtown Louisville facility. The move is part of a national trend, experts say."People are looking very carefully at any financial expenditure," healthcare consultant Peter Young told The Courier-Journal. (C-J Photo by Matt Stone)

Jewish Hospital & St. Mary's HealthCare, which owns the downtown facility, saw a 15 percent drop in in cardiology procedures in 2010 compared to the year before. That translates to 7,000 less cases. In total, surgeries fell almost 9 percent, The C-J's Patrick Howington and Laura Ungar report.

This is the second big cut by Jewish & St. Mary's. In March 2010, it eliminated 500 positions. The latest round of eliminations show why Jewish plans to merge with University Medical Center and Saint Joseph Health System is so important. "Health care is changing, and volumes are dropping while bad debt increases," Jewish Hospital officials said in a statement. "To be effective, growing organizations, we must be flexible and adapt." (Read more)

Whether the Bullitt County Board of Health had the authority to pass a countywide smoking ban is in the hands of Bullitt Circuit Judge Rodney Burress, who heard from the board and representatives of the Fiscal Court objecting to the move Thursday.

In March, the Board of Health passed a ban that would prohibit smoking in bars, restaurants and all public places, including some that are outside. It was supposed to go into effect in September.

But attorneys representing the Bullitt Fiscal Court said the health board has "overstepped its authority by enacting a policy that should have been handed down by a legislative body, such as a city council or Fiscal Court," The Courier-Journal's Charlie White reports.

Margaret Miller, who is helping to represent the board of health, cited the Kentucky statute, which gives boards of health the authority to adopt, implement and enforce regulations to protect people's health.

The Bullitt County Board of Health is not the first in Kentucky to enact such a ban. Health boards in Woodford, Hopkins, Madison and Clark counties did likewise. The move in Hopkins County did result in a legal battle, but the judge sided with the health department and the ruling was not appealed. (Read more)

Thursday, August 25, 2011

Special sections on health are good for community newspapers and their readers. Health-care providers have money for advertising in such sections, and a section focused on health can have more impact on readers than individual, occasional stories.

Based on a pilot project it oversaw in 2007, the Institute for Rural Journalism and Community Issues began recommending to rural newspapers that they schedule health sections as part of editions that are mailed to every postal customer in a paper's home county, a standard circulation-building technique. If a newspaper wants to help improve the health of its community, why not reach everyone in the community?

Last week, one Kentucky newspaper did that. The Adair County Community Voice of Columbia included a 10-page broadsheet section on health in an edition that was mailed to everyone in the county. And though it got no advertising from the local public hospital, with which it has been embroiled in an open-meetings dispute, it did get ads from hospitals in other counties.

Newspapers can mail up to 10 percent of their annual circulation to non-subscribers in their home county at subscriber rates, and can sell "sponsored circulation" to pay the extra cost of printing and postage for the extra copies. The 2007 pilot project with another Kentucky weekly, The Berea Citizen, found that non-subscribers said they were more likely to subscribe if the paper regularly included health information. For a copy of the report on the project, click here. The health section is not online, but PDFs of its pages are posted on the Institute website in a 4.4 MB file, here.

Kentucky has formed a partnership with Ohio, Tennessee and West Virginia to help fight prescription drug abuse, "even as questions linger over how well the state has used its own electronic monitoring resources," reports Mike Wynn of The Courier-Journal.

The Interstate Prescription Drug Task Force will comprise about 30 experts from law enforcement and drug agencies. They are charged to come up with ways to lessen prescription drug abuse and sales. "We do a good job from a law enforcement standpoint, but by working together, we can better identify prescribers, dispensers and patients who are exploiting our borders," Gov. Steve Beshear said in announcing the task force Wednesday.

Task force members will share drug information the state collects on who receives and prescribes certain medications. Kentucky's system is known as KASPER, short for Kentucky's All Schedule Prescription Electronic Recording system. How well the data compiled by the system are being used came into question last week when House Speaker Greg Stumbo, D-Prestonburg, pressed the Kentucky Board of Medical Licensure to explain why it wasn't analyzing the numbers, which it had asked for permission to obtain, Wynn notes.

Critical-access hospitals will get help recruiting physicians to their rural areas through an expanded loan repayment program that is part of President Obama's new jobs initiative for rural America.

The initiative is called the National Health Service Corps, Alexandra Wilson Pecci of HealthLeaders Media reports. The 1,300 critical-access hospitals can use federal loans to recruit new physicians. A press release from the White House states the addition of one primary care physician in a rural community generates about $1.5 million in annual revenue and creates 23 jobs annually.

Kentucky has 30 critical-access hospitals, which must be in rural areas, 35 miles from another hospital or 15 miles from another hospital in mountainous terrain, according to the Rural Assistance Center. The average CAH creates 107 jobs and generates $4.8 million in payroll annually, the White House says.

The jobs program also includes an agreement that will "link rural hospitals and clinicians to existing capital loan programs to help them buy health IT software and hardware and jump the typical rural hospital hurdle of limited access to capital and lower financial operating margins," HealthLeaders Media reports.

A few days before announcing the jobs program, the White House Rural Council released a report that outlined recent investments in rural healthcare access. Those include placing more than 2,600 clinicians in rural communities and providing distance learning and telemedicine services to more than 2,500 rural healthcare and educational facilities. It also highlighted an investment of 500 projects across the U.S. Department of Veterans Affairs health care system that support rural health care. That includes 404 community-based outpatient clinics and 48 outreach clinics in rural areas.

Wednesday, August 24, 2011

An organization representing University of Louisville doctors who were trying to keep their financial records private dropped its lawsuit appealing an adverse open-records decision Tuesday. In April, Attorney General Jack Conway ruled that University of Louisville Physicians Inc. is a public agency and, as such, is subject to the Kentucky Open Records Act. Conway's opinion was requested by The Courier-Journal.

Last November, state auditor Crit Luallen released a scathing audit against Passport, which provides managed care for 165,000 Medicaid patients in Jefferson and 15 surrounding counties. The audit accused the organization of "wasteful spending, conflicts of interest and the questionable transfer of $30 million in Medicaid funds to organizations represented on Passport's board, including University Physician Associates," The Courier-Journal's Tom Loftus reports. Because of the audit, the newspaper asked for financial records from University Physicians Associates and University of Louisville Physicians Inc., which is the successor to University Physicians Associates. They refused to hand over the records, and Conway's decision followed.

Though the attorney general determined the organization should be subject to the open-records law, and the doctors' lawsuit has been dismissed, giving Conway's opinion the force of law, The Courier-Journal may not receive the records it has asked for. In its notice of dismissal, University of Louisville Physicians stated it could change "its structure and function in the future which it believes may alter its status as a public agency."

"We are still forming our final structure and function," Diane Patridge, ULP's vice president for marketing and communications, told Loftus. "Once we're up and fully established we may appeal this current determination." Curiously, "Partridge also said that ULP has no records to release to the newspaper as a result of the dismissal of the case," because it has no employees -- even though it was incorporated in March 2010. "She said University Physicians Associates . . . has handled all financial matters and paperwork for ULP to date," Loftus reports.

“This case is another piece of a puzzle,” Courier-Journal attorney Jon Fleischaker said. “It’s another step to try to make sure there’s more transparency at the University of Louisville School of Medicine and University Medical Center.” (Read more) "Sounds like a shell game with shell corporations," said Al Cross, director of the Institute for Rural Journalism and Community Issues and associate extension professor of journalism at the University of Kentucky.

As hospitals and other health-care providers in Kentucky and across the country are adopting electronic health records to save money and improve care, they do so at some risk. The medical files containing insurance forms, Social Security numbers and doctors' notes of about 300,000 Californians were posted recently on the Internet, available to anyone who might stumble across them or know how to search for them. "At a time of mounting computer hacking threats, the incident offers an alarming glimpse at privacy risks as the nation moves steadily into an era in which every American's sensitive medical information will be digitized," The Associated Press reports.

"When things go wrong, they can really go wrong," said Beth Givens, director of Privacy Rights Clearinghouse, a nonprofit that tracks data breaches. "Even the most well-designed systems are not safe ... This case is a good example of how the human element is the weakest link."

Generally, data breaches are the result of hackers who break into computers or thieves who steal the actual equipment. Sometimes they can just be be caused by human error. Leaks can also happen as data passes through health industry networks. "Dozens of companies can be authorized to handle a single person's medical records," the AP reports. "The further away from the health care provider the records get, the flimsier the enforcement mechanisms for ensuring the data are protected."

One of the biggest breaches was in 2006 when a laptop containing data for 26.5 million veterans was stolen from the home of a government employee. The computer was recovered. This year, hard drives containing personal information of 1.9 million Health Net insurance customers were taken. They contained health histories, financial information and Social Security numbers. The matter is still under investigation.

In the wrong hands, "health records can be used for blackmail and public humiliation," AP notes. "The information can also be used by insurance companies to inflate rates, or by employers to deny job applicants."

Preventing data leaks is on the minds of Kentucky officials setting up the Kentucky Health Information Exchange, the state clearinghouse for EHRs. Participating providers have to sign several agreements in which they attest the information they obtain will be used responsibly. "The golden rule is this data will only be viewed by a provider who is providing care to a patient," said Jeff Brady, executive director of the Governor's Office of Electronic Health Information. To make sure that is happening, Brady said the software has an audit function, in which administrators are able to see who looks at a patient's data, when they did, from what computer and what piece of data was examined. (Read more)

Tuesday, August 23, 2011

Despite a recent request to delay by an advisory council, and a low number of signups by hospitals so far, the move to managed care for Kentucky's Medicaid patients should be completed by Oct. 1.

"We are prepared to proceed with an Oct. 1 timeframe," said Janie Miller, secretary of the Cabinet for Health and Family Services, right, as she updated the Medicaid Oversight and Advisory Committee Monday. "I know it is quick and it is coming."

The advisory council had asked the cabinet to delay, saying the Oct. 1 deadline did not give providers enough time to review contracts. Several legislators also feel the move is happening too quickly. "Oct. 1 just seems a little scary for some of us," said Sen. Julie Denton, R-Louisville. She said "doctors, pharmacists and other providers have contacted her to voice concerns that they don't have enough information about which managed care company to sign on with," Deborah Yetter of The Courier-Journal reports.

As of last Wednesday, "Only 15 or so of the state’s [109] hospitals had signed on with one of the three managed care providers," according to Miller, Ronnie Ellis reports for CNHI News Service. "She said she wants to see about 89 hospitals join one or more of the three networks but the contracts provide for “out of network” services if enough hospitals don’t join in rural or isolated areas." (Read more)

The move to managed care organizations is the state's answer to plug a $139 million hole in the Medicaid budget. Privatizing the program by using managed care will mean providers will be paid on a per-patient, per-month basis, which Gov. Beshear said will save $1.3 billion over three years. Right now, providers are paid on a fee-for-service basis, meaning they bill for each service that is provided. The move will affect more than 730,000 Kentuckians and will be run by four MCOs statewide, including Passport. As it has for several years, Passport will continue to provide managed care for 170,000 Kentuckians in Jefferson County and the surrounding area.

Within two weeks, 560,000 Kentuckians outside of the Passport jurisdiction will receive information packets about which of the other three companies will handle their care. Membership cards will be mailed in September, Yetter reports. Before the new program can be launched, the state must showed the federal Centers for Medicare and Medicaid Services it is ready. Miller said that if the program is not deemed to be ready, there would be a delay, Yetter reports. (Read more)

The University of Kentucky Cooperative Extension Service has created an online challenge designed to help people improve their health and financial status. The Kentucky Fall 2011 Small Steps to Health and Wealth challenge starts Sept. 4 and runs to Oct. 2.

The free program asks participants to track daily choices they make about nutrition, physical activity and saving money. As they enter data into 10 categories, participants will earn points and see a comparison of their progress to other participants. Top finishers will receive prize packs. The first 150 people to complete the challenge will get a UK water bottle.

"As individuals work toward improving both their health and personal finances, it is important to realize that small changes do make a difference," said Jennifer Hunter, UK assistant extension professor for family financial management in the UK College of Agriculture. "Adopting only one of the 10 recommended daily practices is a step in the right direction."

Friday, August 19, 2011

Update, Aug. 29: The Kentucky Board of Medical Licensure may not be tracking the prescribing practices of the state's doctors, but that's because it can't, asserts a past president of the Kentucky Academy of Family Physicians in an op-ed piece in the Lexington Herald-Leader.

"Although the board may use KASPER to observe a given physician's prescribing history for a period of time, it may do that only if provided a name," Dr. E.C. Seeley writes. "By law, the board may not identify a physician by any means, including KASPER, unless receiving a grievance. Consequently, if the board lacks that capacity, the agency administering KASPER or the legislature should receive the criticism, not the medical board." (Read more)

House Speaker Greg Stumbo has filed an open records request to find out why the Kentucky Board of Medical Licensure hasn't been more aggressive in tracking physicians that are over-prescribing pain medication, The Courier-Journal's Mike Wynn reports.

The request asks for documents, e-mails, letters and related files that show information on the board's use of KASPER, the state's drug-tracking system. "After wanting to make an issue, after wanting help, why did they disband the effort," said Stumbo, right. "I want to see what they said, what they talked about, what their motives were."

Stumbo broached the issue with the board Tuesday in a legislative Program Review and Investigation committee meeting. He pointed out the board had shown signs it was interested in pinpointing physicians that were overprescribing medication. In 2003, the licensing board asked to be able to analyze data collected in KASPER. That same year, the legislature passed a law allowing the Cabinet for Health and Family Services, which maintains KASPER, to release geographical data about prescriptions to the board so it could perform its analysis.

But the board's attorney said Tuesday the data collected is not specific enough and the board doesn't have the staff to perform the detailed analysis that would be required.

Stumbo suggested the board increase its fees if it needs more staff.

KASPER can produce by-county trend reports, Wynn reports. Though less than 30 percent of the state's physicians use the system, Stumbo said the data is complete enough to be able to identify suspiciously high prescription rates. (Read more)

"As Stumbo said, it's obvious we have a problem," the editorial reads. "In KASPER it's also obvious that Kentucky has a tool that could direct investigators to doctors who might be prescribing too many pain pills. It seems equally obvious that using that tool to address a problem that's destroying lives and costing our state dearly is not only reasonable but essential." (Read more)

The Centers for Disease Control and Prevention have issued $49 million in grants to improve public health, $815,000 of which is earmarked for Kentucky.

The Kentucky Cabinet for Health and Family Services will use the funds to expand its epidemiology, lab and health information systems and to detect and prevent healthcare associated infections. Each year, about 100,000 people die nationwide because of these infections, which are often acquired in hospital settings. The funds are meant to help states coordinate HAI prevention, implement multi-facility prevention efforts, improve monitoring of antimicrobial use and enhance electronic reporting.

Every state in the country will receive a portion of the $49 million pot, which is double the size that was handed out in 2010. "This funding will be used to create jobs, enabling the hiring and training of epidemiologists, laboratory scientists and health information specialists in the field of infectious diseases," said Thomas Frieden, director at the CDC. "These grants will also make it easier for health departments to better manage and exchange important information." (Read more)

Thursday, August 18, 2011

"In the face of poverty and other economic woes, Kentucky is one of the worst states in the nation when it comes to children's health," reports Jenna Mink of Bowling Green's The Daily News.

The state ranked 41st, according to the Annie E. Casey Foundation's 2011 Kids Count Data Book. "We no longer are close to being a bottom-10 state. We are among the bottom 10 states," said Terry Brooks, executive director of Kentucky Youth Advocates.

Kentucky scored particularly low when it came to child poverty, ranking third highest in the country. The study found 26 percent of Kentucky children live in impoverished homes. Kentucky also ranked low because of its poor economy and because it ranked high in the number of babies that are born with low birth weights, which can cause anything from infant death to behavioral and learning disorders. "While some causes are associated with chronic diseases among mothers, such as diabetes, Kentucky tends to have a high rate due to smoking during pregnancy," Mink reports.

The state also ranked high in terms of the number of children who have at least one parent unemployed. In 2010, about 122,000 Kentucky children had at least one parent who was looking for work. Only four other states and the District of Columbia had higher rates.

Brooks said Kentucky can improve its standing, and improve the welfare of its children, by doing three things. "First, Kentucky families should be given more information about benefits for which they qualify — last year, Kentuckians left $300 million in unclaimed benefits, such as food stamps and tax credits," Mink reports.

Brooks said he is also strongly in favor of passing a state earned income tax credit, which he said would help families make ends meet. Lastly, he recommends cracking down on businesses that advertise payday loans. "Those kinds of predatory practices contribute to the high price of being poor in Kentucky," he said.

The results of the report were not all bad, however. Kentucky improved on the number of teenagers who stay in school. The average number of kids in Kentucky affected by foreclosure was also lower than the rest of the country. Compare 2.3 percent, or 38,000 children, to the nation's average of about 4 percent. Brooks said the disparity is due to the fact that many Kentuckians rent and live in rural areas. (Read more)

Wednesday, August 17, 2011

The University of Kentucky has received a $7 million grant to continue its research on Alzheimer's disease. The research is conducted at the Sanders-Brown Center on Aging and involves clinical trials and comparing brains diseased by Alzheimer's to those that are not.

"It is the second major grant announcement for UK in two days," reports the Lexington Herald-Leader's Cheryl Truman. "On Monday, UK received a $14.5 million grant to develop pollution-catching technologies for coal-fired power plants."

The grant proves UK "is not only able to compete among the big boys but be one of the big boys" when it comes to Alzheimer's research and treatment, said Michael Karpf, UK's executive vice president of health administration.

At the Sanders-Brown center, more than 700 research volunteers from around Kentucky take part in clinical trails and a brain donation program, which allows researchers to compare Alzheimer's-affected brains to those that aren't. (Read more)

If the Kentucky Board of Medical Licensure doesn't increase its oversight on doctors who prescribe excessive amounts of pain pills, House Speaker Greg Stumbo said Tuesday he'll find an agency that will. "If the medical licensure board refuses to do its job, then we will try to find some entity in the enforcement community that wishes to do that," said Stumbo, D-Prestonsburg, right.

In 2003, the licensing board asked to be able to analyze data from the Kentucky All Schedule Prescription Electronic Reporting registry — known more commonly as KASPER — so it could identify over-prescribing doctors. That same year, the legislature passed a law "that would allow the Cabinet for Health and Family Services, which maintains KASPER, to provide geographical data about prescriptions for controlled substances. The licensing board could use that data to determine whether doctors were overprescribing controlled substances in areas that had high prescription rates," the Lexington Herald-Leader's Beth Musgrave reports.

But the board had not used the data, Stumbo said.

Lloyd Vest II, the licensing board's general counsel, said the data was not used because it was not specific enough. The cabinet informed the board it did not have the legal right to analyze the data in depth, he added.

Stumbo informed Vest the board is the only agency that had the legal authority to study the information.

Bill Schmidt, the board's executive director, said the board, which does not receive any government funding, does not have the staff to deal with the data analysis Stumbo is asking for. "The board had five investigators to police nearly 10,000 doctors," Musgrave reports. Stumbo said the understaffing issue could be solved by raising licensing fees and assessment prices on doctors.

Board members said they will return to committee in December with suggestions for how the state can better police doctors' prescription practices.

Data show drug overdoses is the leading cause of death for some age groups in Kentucky. Federal statistics show 6.5 percent of Kentuckians have abused prescription drugs. (Read more)

Monday, August 15, 2011

Childhood obesity and drug abuse are the top two worries for children. Those were the results of a University of Michigan poll that asked people to rate 23 different health concerns for kids living in their communities. When it came to obesity and drug abuse, 33 percent of people rated them as being the biggest problems, research-reporting service Newswise reports.

In 2007, 37 percent of Kentucky children were either obese or overweight, Childhood Obesity Action Networknumbers show. Drug abuse, particularly of prescription pills and methamphetamine, is likewise a notable problem in Kentucky.

Smoking and tobacco use came in third place, followed by teen pregnancy, bullying, Internet safety, stress, alcohol abuse, driving accidents and sexting. Internet safety and sexting are new to the top 10 list.

"The perception of drug abuse as a big problem matches recent national data showing increasing use of marijuana and other drugs by U.S. teens," said Matthew Davis, director of the National Poll on Children's Health.

"Meanwhile, although obesity remains at the top of the list of child health concerns for the fourth straight year, the level of public concern has declined over the last few years in our poll," Davis said. "This may be a warning to public health officials, because it indicates how the public is hearing national messages that previous increases in children's obesity rates have recently leveled off." (Read more)

The massive switch to managed care organizations for Kentucky's Medicaid program, pushed by Gov. Steve Beshear, isn't in the bag yet. The Advisory Council for Medical Assistance, which advises officials on Medicaid issues, has asked that the switch be delayed by 90 days. It is supposed to happen Oct. 1, the Lexington Herald-Leader's Jack Brammer reports. (Photo by H-L's Pablo Alcala)

"All we're asking for is to give everybody more time to get this thing implemented," said Ron Poole, who represents the Kentucky Pharmacists Association. "We're 49 days away, and all practitioners and providers have not yet received a contract ... They need time to review the contracts and determine if they want to participate."

Poole told Brammer he didn't think the request to delay would be granted, but insisted it's needed. Jill Midkiff, a spokewoman for the state health cabinet, said she could not comment on the request because "it had not received any notification or official recommendation from the council," Brammer reports.

The move to managed care is the state's answer to plug a $139 million hole in the Medicaid budget. Privatizing the program will mean providers will be paid on a per-patient, per-month basis, which Gov. Beshear said will save $1.3 billion over three years. Right now, providers are paid on a fee-for-service basis, meaning they bill for each service that is provided. The move will affect more than 800,000 Kentuckians. (Read more)

In an op-ed piece in the Lexington Herald-Leader, Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, encourages school districts to adopt comprehensive tobacco-free policies.

"Many believe that schools are already tobacco-free, but this is only partially true," she writes. "While smoking is prohibited inside school buildings, weak policies at many schools mean staff and students continue to light up on school grounds. About 10 percent of Kentucky high school students report smoking on school property, according to the 2009 Kentucky Youth Risk Behavior Survey."

Zepeda encourages school districts to adopt tobacco-free school policies, which prohibit tobacco products for anyone on school property or at school-sponsored events, such as field trips and sporting events.

"The 2010 Kentucky Health Issues Poll shows that nearly nine in 10 (86 percent) Kentuckians favor 100 percent tobacco-free school policies," Zepeda writes. "While support for these policies was strongest among those who have never smoked, a solid majority of current smokers (75 percent) also supported 100 percent tobacco-free school policies. Clearly, 100 percent tobacco-free policies are an easy win for school districts." (Read more)

A gathering intended to bring Kentuckians together who get care, give care, purchase care and pay for care will be Wednesday, Aug. 24 at the Capital Plaza in Frankfort.

The Kentucky Health Quality collaborative conference will focus on current quality improvement efforts in Kentucky and will address changes that are happening through health reform and national efforts to improve health care. The keynote address will look at the national quality strategy that drives reporting and payment incentives.

The Foundation for a Healthy Kentucky will host another webinar this Wednesday as part of its Health for a Change training series. This session will focus on the differences between lobbying and advocacy work done by non-profit organizations. The session will be presented by April Carson, a legislative advisor and counsel at Alliance for Justice.

Another training webinar will be hosted at 3 p.m. Wednesday, Aug. 24 and will focus on communication with policymakers. It will help listeners learn about the basic rules needed to figure out how public policy is made in state, county and local governments and how to become involved in the policy-making process.

The Health for a Change training series is geared to community health coalitions, agencies, businesses, advocacy organizations and individuals looking to improve skills, create community participation and create health changes at the local level. The sessions run until December. (Read more)

Wednesday, August 10, 2011

Tara Kaprowy, the chief writer for Kentucky Health News, won one of the first awards given by the Kentucky Rural Health Association for newspaper writing.

Kaprowy won the prise for best series in a non-daily newspaper for her five-part series in The Sentinel-Echo of London titled “How Healthy Are We?” The August 2010 series examined how Laurel County compared to state and national averages for tobacco use, obesity, access to health care, and so on.

Ivy Brashear, formerly of The Hazard Herald, won prize for best story in a non-daily paper for her April 6, 2011, article, “Health study has Perry near the bottom,” about a Population Health Institute study that ranked Perry’s health status as 115th among the state's 120 counties. There were no daily entries; each winner received a plaque and $100 prize.

These types of reports can be done by any news outlet in Kentucky, because plenty of data are available on sites such as http://www.kyhealthfacts.org/. For a look at Kaprowy's series, go here.

Tuesday, August 9, 2011

Though the Department of Agriculture has recommended that most of a dinner plate should be filled with foods rich in potassium, dietary fiber, vitamin D and calcium, a new study says adopting such a diet "would add hundreds more dollars to (Americans') grocery bill," reports Donna Gordon Blankinship of The Associated Press.

Adding more potassium to one's diet alone could add $380 per year to the average person's food costs, a paper published in professional journal Health Affairs found. Lead researcher Pablo Monsivais, an assistant professor at the School of Public Health at the University of Washington, objected to how healthy eating is marketed, with ads showing a plate of salmon with green, leafy veggies and rice pilaf. Many Americans cannot afford to eat that way, he said.

He added some government policies are helping to cut down on the cost of fruit and vegetables, but some policies create problems. A state policy in Washington makes it difficult to buy potatoes with food assistance coupons, despite the fact that eating potatoes is an inexpensive way to gain potassium.

The study was based on a random telephone survey of about 2,000 adults in a county in Washington. It was followed up by a printed questionnaire, to which 1,300 people responded. Hilary Seligman, an assistant professor of medicine at the University of California, found the results eye-opening. A lot of people assume the poor eat cheap food because it tastes good, but they would make better choices if they could afford to, she said. (Read more)

Monday, August 8, 2011

Kentucky and Ohio are now automatically exchanging data on prescription drugs, with a new electronic network called the Prescription Monitoring Information Exchange. PMIX links the Kentucky All- Schedule Prescription Electronic Reporting (KASPER) system and the Ohio Automated Rx Reporting System (OARRS). Now perhaps all we need is a Big Old Automatic Terminal (BOAT) so Kasper can row it with the Ohio oars.

Kidding aside, "The announcement marks a highly anticipated milestone for prescription drug monitoring programs and ongoing work to fulfill a need to share data across state lines," Gov. Steve Beshear's office said in a press release. "Kentucky’s Cabinet for Health and Family Services oversees KASPER, which is considered a national model for prescription drug monitoring." The Ohio-Kentucky linkup is federally funded.

Authorized users in the two states can securely access prescription monitoring data from both systems. "A physician in Kentucky will be able to request a KASPER patient report and stipulate that they need Ohio data included on the report," the release says. "Doctor shoppers often seek controlled substances from multiple providers and cover increasingly large territories to obtain the drugs."

Kentucky and several other states allow a prescriber, dispenser, or law-enforcement officer from another state to register and get their prescription data, but "Due to the effort required to establish and maintain separate accounts with each state and review multiple reports and formats, only a limited number of practitioners and law enforcement officers have done so," the release says, then quotes KASPER coordinator Dave Hopkins: “We think the PMIX pilot will facilitate efforts to share prescription drug monitoring program data among all states.”

Dr. Andrea Yancey, a vascular surgeon from Louisville, has completed two weeks of volunteer service treating wounded American soldiers transported from Afghanistan and Iraq to the U.S. Army’s Landstuhl Regional Medical Center in Germany.

“I now have a better understanding and enhanced respect and appreciation for our military,” Yancey said in a press release from the Society for Vascular Surgery, which has provided continuous two-week rotations of vascular surgeons at LRMC for the past four years, the release said.

“The soldiers were young, polite, and grateful,” Yancey said. “Their mental and physical toughness and capacity for resilience were hard to comprehend. In spite of their injuries, they never complained or asked for pain medicine. They did not want to inconvenience anyone.”

Yancey is an assistant professor of surgery at the University of Louisville and a surgeon at the Robley Rex Veterans Affairs Medical Center in Louisville.

Kentuckians gathered in several places Saturday to show their support of breast feeding. Events were held in Ashland, Edgewood, Lexington, Louisville, Nicholasville, Owensboro and Paducah as a part of the Big Latch On, “a one-minute synchronized nursing event in multiple locations” sponsored by the La Leche League USA, Valarie Honeycutt Spears of the Lexington Herald-Leader reports. (H-L photo)

Shayna Chasteen of London told Spears she attended the Lexington event “to help make other mothers aware of the benefits of breast-feeding and to promote ‘normalizing breast-feeding in public.” Brion Barnhill, the only father who attended the Lexington event, told Spears, “Luckily my wife cares more about my baby’s health than what somebody else thinks.”

Kentucky law supports breast feeding, allowing mothers to breast-feed or express milk in any public or private location without it being considered public indecency or indecent exposure, Spears reports. “We stress breast-feeding as the gold standard in infant feeding, because of the nutritional and health advantages it provides,” Cabinet for Health and Family Services Secretary Janie Miller said in a statement. “Women have more success with breast-feeding when they receive consistent and accurate information and are supported by their health care providers, family and community.” (Read more)

The Big Latch On was part of the World Breastfeeding Week, Aug. 1-7. To learn more about the event or locate a La Leche League in your area, click here.

With teens expected to turn to tanning beds in the fall to keep their bronzy summer glow, parents are encouraged to talk about the dangers of "fake baking."

"Using tanning beds before age 30 increases a person's risk of melanoma, the deadliest form of skin cancer, by 75 percent, research shows," said Dennis Hughes, assistant professor of pediatrics at M.D. Anderson Children's Cancer Hospital in Houston. "So, it's important to talk to your kids about tanning beds just like you'd discuss smoking, sex, drugs and alcohol."

Research-reporting service Newswise says 35 percent of 17-year-old girls have used tanning beds. One study showed tanning beds are addictive, with 80 percent of college kids who habitually tan saying they could not stop. Access to the facilities is easy, with an analysis of 116 American cities showing that tanning salons outnumber Starbucks or McDonald's.

Parent should talk to their children before they start frequenting tanning facilities, Hughes said. Children should know tanning beds emit the same harmful ultraviolet light as the sun and, consequently, are not safe. Rather than making them look attractive, "explain that tanning will actually make them look worse" in the long run, Hughes advised. (Read more)

Friday, August 5, 2011

Dr. Rice Leach, who has championed public health in Kentucky for decades, is inspiring many by the upbeat way he is battling cancer. "He has talked about it at Lexington-Fayette County Board of Health meetings and at Rotary Club meetings. His hat of choice, a gift his son John bought at Cracker Barrel, reads 'I'm having a no hair day,'" the Lexington Herald-Leader's Mary Meehan reports.

Leach was Kentucky's commissioner for public health from 1992 to 2004. He is now commissioner of Fayette County's health department, which has undergone a tumultuous transition after the very public replacement of Dr. Melinda Rowe. "I've really admired his dedication to the job," Geoff Reed, a senior adviser to Mayor Jim Gray, told Meehan. "He's just that kind of person who shows real passion in everything he does."

Leach, 71, has lymphoma, a cancer of the lymph nodes for which he is being treated with several rounds of chemotherapy and radiation. Meehan reports how Leach drew inspiration from the example set by his daughter, Mary Leach Whitcomb, who bravely fought breast cancer until her death in 2007. "If that 37-year-old can handle that big mess, you better believe I can handle this," he said. Meehan's piece provides a good example of how to write sensitively and informatively about a difficult subject. (Read more)

The switch to managed care organizations has fixed Kentucky's Medicaid shortfall, with Janie Miller, secretary of health and family services, calling the budget "balanced." She said the projected savings from moving to managed care will take care of the $97 million funding gap caused by a lack of anticipated federal funding.

The Courier-Journal's Deborah Yetter notes that the shortfall was the most contentious issue for the legislature this year, with Gov. Steve Beshear wanting to plug the hole by moving to managed care and Senate Republicans wanting to make across-the-board budget cuts. After a special session, Beshear got his way and 560,000 Medicaid members are slated to move into managed-care organizations starting Oct. 1. Those in the Louisville region have been in one, Passport, for several years. Passport has a one-year contract with the state; Coventry Health Care Inc., Centene Corp. and WellCare Health Plans Inc. have three-year contracts. "They have every incentive to be successful," Miller said. "They are making a huge investment in this state."

Asked by skeptical legislators how the savings can be assured, Miller said they are guaranteed by the contracts. "To achieve savings, Medicaid will pay each company a fixed rate of about $345 per month per person. In turn, the company will be responsible for all costs of the person's health care," Yetter reports. "It's got a lot of potential," said state Rep. Jimmie Lee, D-Elizabethtown. "I have faith that if it's managed right, it could work." (Read more)

Tuesday, August 2, 2011

Though rural Americans have more chronic health conditions than those who live in urban centers, they have poorer access to health care, a working paper released last month confirms. Health experts are pointing to technology, including telemedicine, to help bridge the gap.

The paper was compiled by the UnitedHealth Center for Health & Reform Modernization, an arm of the nation's largest health insurer. It found "there are only 65 primary care physicians per 100,000 rural Americans — 40 or so less than the 105 per 100,000 urban and suburban Americans," Molly O'Toole of Reuters reports. "Already five million rural residents live in 'shortage areas' defined by the government as counties with less than 33 primary care physicians per 100,000 residents." The problem intensifies when it comes to specialists, with rural areas having fewer than half the number of surgeons and other specialists per capita.

Kentucky is one of the more rural states, with the latest U.S. Census numbers showing that about 42 percent of its population lives in rural areas.

The study incorporated results of a survey of about 3,000 patients and primary-care physicians. It found drug abuse and teen pregnancy are bigger concerns in rural areas than in cities. Rural people tend to think their local health care is lower in quality than in urban centers. In many instances, they're right. "UnitedHealth confirmed this 'equality deficit' is supported by data showing that in 70 percent of markets, rural quality of care was measurably worse than in urban areas," O'Toole reports.

To remedy the situation, the report advises expanding the role for nurse practitioners and incorporating more mobile health clinics, technology such as telemedicine and preventive care into health care. (Read more)

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. Thanks!